| NPI | 1801205323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 76704) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX R1247) |
| 207P00000X Emergency Medicine (Licence: GA 86876) | |
| Enumeration Date | 2014-08-08 |
| Last Update Date | 2024-04-11 |